| NPI | 1265770440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT022351) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9107081) |
| 363A00000X Physician Assistant (Licence: PA MA061590) | |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2023-05-18 |